Provider Demographics
| NPI: | 1982878765 |
|---|---|
| Name: | PARKVIEW ANCILLARY SERVICES CORPORATION |
| Entity Type: | Organization |
| Organization Name: | PARKVIEW ANCILLARY SERVICES CORPORATION |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT/CEO |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | LESLIE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | BARNES |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 719-584-4573 |
| Mailing Address - Street 1: | 58 CLUB MANOR DR. |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PUEBLO |
| Mailing Address - State: | CO |
| Mailing Address - Zip Code: | 81008-1601 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 719-584-4045 |
| Mailing Address - Fax: | 719-542-0809 |
| Practice Address - Street 1: | 1619 N. GREENWOOD AVE. |
| Practice Address - Street 2: | STE. 106 |
| Practice Address - City: | PUEBLO |
| Practice Address - State: | CO |
| Practice Address - Zip Code: | 81003-2655 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 719-584-4045 |
| Practice Address - Fax: | 719-542-0809 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2008-04-14 |
| Last Update Date: | 2022-05-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| CO | 207Q00000X, 207QA0000X, 207RC0000X, 207RC0200X, 207RE0101X, 207RI0200X, 207X00000X, 2081N0008X, 208600000X, 208G00000X | |
| 207R00000X, 207RG0100X, 207T00000X, 2084N0400X, 2084P0800X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207QA0000X | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | Group - Multi-Specialty |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 2081N0008X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Neuromuscular Medicine | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CO | 16177754 | Medicaid | |
| CO | 12701378 | Medicaid | |
| CO | 24539716 | Medicaid | |
| CO | 29734860 | Medicaid | |
| CO | 81531869 | Medicaid | |
| CO | 95682872 | Medicaid | |
| CO | 26834774 | Medicaid | |
| CO | 63027348 | Medicaid | |
| CO | 74808583 | Medicaid | |
| CO | 96470259 | Medicaid | |
| CO | 99437767 | Medicaid | |
| CO | 07725779 | Medicaid | |
| CO | 14589265 | Medicaid | |
| CO | 26973898 | Medicaid | |
| CO | 27728757 | Medicaid | |
| CO | 49478541 | Medicaid | |
| CO | 36083372 | Medicaid | |
| CO | 38829584 | Medicaid | |
| CO | 56139071 | Medicaid | |
| CO | 59270748 | Medicaid | |
| CO | 89236751 | Medicaid | |
| CO | 67720587 | Medicaid | |
| CO | 20875576 | Medicaid | |
| CO | 23073055 | Medicaid | |
| CO | 29588855 | Medicaid | |
| CO | 22584226 | Medicaid |
